Background: Understanding the association between caregiver belief systems and practice patterns is an emerging area of research. We hypothesized an association between a maternity caregivers belief system and his or her behavior. The study objective was to determine if a family physician’s overall approach to maternity care, cis measured by average use of epidural analgesia, was associated with maternal and fetal outcomes.

Methods: Retrospective analysis was conducted of the births of three cohorts of 1992 nulliparous, low- risk women attended by 96 family physicians within an 18-month period in the department of family practice at the largest maternity hospital in Canada. Cohorts were based on the physicians’ mean use of epidural analgesia for the women. Family physicians attending fewer than 5 births were excluded. The main outcome measures, by, physician epidural utilization cohort, were maternal/newborn morbidity, procedure rates, consultation rates, and length of stay.

Conclusions: In our setting, high use of epidural analgesia is a marker for a style of practice characterized by malpositions leading to dysfunctional labors and higher intervention rates leading, in turn, to excess maternal/newborn morbidity

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High use of epidural analgesia is a marker for a style of practice characterized by malpositions leading to dysfunctional labors and higher intervention rates leading, in turn, to excess maternal/newborn morbidity